Treatment Cost of Heavily Treatment-Experienced Adult Patients With Multi-Drug Resistant HIV-1 Infection in Brazil

OBJECTIVES: Patients with multidrug-resistant (MDR) HIV-1 infection and CD4+ cell deficiency face significant challenges in their treatment. Low CD4+ cell counts may be associated with a higher incidence of opportunistic infections, HIV/AIDS complications, and a need for complex and potentially more expensive therapies. The aim of this study was to analyze the direct costs of a heavily treatment-experienced patient with MDR HIV-1 infection.

METHODS: A health state transition model was developed to estimate the direct costs over a lifetime horizon of a heavily treatment-experienced patient with MDR HIV-1 infection. The following resources were captured: antiretroviral therapy (ART) regimens; outpatient, emergency, and hospitalization visits; monitoring tests (e.g.: HIV-1 RNA, CD4+ cell count, ART resistance); opportunistic infection (OI) prophylaxis; adverse event management; end-of-life care; and AIDS-defining events (OI management).

RESULTS: The total cost of a patient is BRL 100,528, 77% of which is related to ART regimens, with maraviroc and enfuvirtide representing the costly treatments and being included in 19% and 10% of optimized background therapy (OBT) regimens, respectively. The remaining 23% of costs are allocated to HIV care. Of this portion, the most significant distribution of costs is observed in patients with the lowest CD4+ cell count: CD4+ <50: R$9,047; CD4+ 50-<200: R$7,940; CD4+ 200-<350: R$2,884; CD4+ 350-<500: R$1,258; CD4+ ≥500: R$810. Opportunistic infection prophylaxis accounted for BRL 155 and end-of-life care BRL 1,455.

CONCLUSIONS: Patients with lower CD4+ cell counts require a higher level of healthcare resources with the potential to overload the system with higher costs for treatment and disease control. New technologies aimed at controlling the progression of HIV-1 and CD4+ cell counts can contribute to better quality of life and reduced healthcare resource utilization by the Sistema Único de Saúde (SUS).